The intestinal fatty acid-binding protein as a marker for intestinal damage in gastroschisis.

Alena Kokesova,Barbora Frybova,Michal Rygl,Stepan Coufal,Miloslav Kverka,Camilia R Martin

doi:10.1371/journal.pone.0210797

Abstract

Background/PurposeWe analyzed the capacity of urinary Intestinal fatty acid-binding protein (I-FABP) to quantify the degree of mucosal injury in neonates with gastroschisis (GS) and to predict the speed of their clinical recovery after surgery.MethodsIn this prospective study, we collected urine during the first 48h after surgery from neonates operated between 2012 and 2015 for GS. Neonates with surgery that did not include gut mucosa served as controls for simple GS and neonates with surgery for intestinal atresia served as control for complex GS patients. The I-FABP levels were analyzed by ELISA.ResultsUrinary I-FABP after the surgery is significantly higher in GS newborns than in control group; I-FABP in complex GS is higher than in simple GS. I-FABP can predict subsequent operation for ileus in patients with complex GS. Both ways of abdominal wall closure (i.e. primary closure and stepwise reconstruction) led to similar levels of I-FABP. None of the static I-FABP values was useful for the outcome prediction. The steep decrease in I-FABP after the surgery is associated with faster recovery, but it cannot predict early start of minimal enteral feeding, full enteral feeding or length of hospitalization.ConclusionUrinary I-FABP reflects the mucosal damage in gastroschisis but it has only a limited predictive value for patients’ outcome.

Highlights

Gastroschisis (GS) is a congenital anomaly of the abdominal wall, which results in extrusion of abdominal viscera from the abdominal cavity
Urinary Intestinal fatty acid-binding protein (I-FABP) after the surgery is significantly higher in GS newborns than in control group; I-FABP in complex GS is higher than in simple GS
The steep decrease in I-FABP after the surgery is associated with faster recovery, but it cannot predict early start of minimal enteral feeding, full enteral feeding or length of hospitalization

Summary

Introduction

Gastroschisis (GS) is a congenital anomaly of the abdominal wall, which results in extrusion of abdominal viscera from the abdominal cavity. I-FABP (Intestinal fatty acid-binding protein) is present in the cytoplasm of mature enterocytes in the small and large intestine and is released as soon as the cell membrane integrity is compromised, reflecting the extent of gut damage It is used as a biomarker of mucosal injury and other diseases affecting the intestine [4]. Serum I-FABP correlates with the severity of villous atrophy in coeliac disease and with Crohn’s disease activity [5, 6] It is increased after abdominal surgery or infection and can be used as a biomarker of acute gut mucosa damage in necrotizing enterocolitis (NEC) or distinguish it from neonatal sepsis [7,8,9]

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